Tuesday, 7 August 2012

How to get Authorization from OrthoNet for Physical Therapy and Occupation therapy for Anthem members living in state of New Hampshire and Connecticut?

Anthem has delegated Medical Management responsibilities for physical and occupational therapy services to OrthoNet for its New Hampshire and Connecticut members. Effective January 1, 2010,  OrthoNet’s scope of responsibility includes the management of the prior-authorization process for outpatient therapy services. In Connecticut, the following programs products and plans are excluded from the prior authorization requirement for physical and occupational therapy services: Medicare supplement, MediBlue, Smart Value PFFS, Federal Employee Program (FEP), BlueCard Host, NEHP Host and Taft-Hartley.

We need to submit the therapy request form to OrthoNet and need to fill the below information. Its need to be fax #1-888-788-0809

Therapy Provider Information
  • Facility Name
  • Street Address
  • City
  • State
  • Zip
  • Telephone Number
  • Fax Number
  • Anthem Provider ID Number
  • National Provider Identifier (NPI)
Patient Information
  • First Name
  • Last Name
  • Member ID Number
  • Date of Birth
Request Information
  • Service Type
  • Initial Evaluation Date
  • Diagnosis Code
  • If this request for post or pre-operative therapy visits
  • Management Service
You will find this Authorization template in the below link:


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